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| Performing Windplayer Medical Problem |
| Welcome and please take the time to check out this page. It is quite informative to many sax players as well as other wind players, however since sax is my specialty that is where my focus lies. I have provided links to sites that explain not only medical problems that effect wind players, but other musical instruments as well. Some are little known problems except for the few who experience them. There is nothing natural about playing any physical instrument except the voice. Even that plus each of the other instruments have their own unique set of stresses on the human body. |
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| My Story |
| While playing in group in 1987 I was in the middle of a solo and blowing hard as usual when I felt what seem to be like a balloon expanding in my nasal passage. The sensation continued until I felt a small stream of air escaping through my nose. The leak continued to progress and I started hearing a buzzing sound and then pain as though something was stabbing or raking inside my nasal cavity. Needless to say I was finished blowing for the night. It was a Saturday night and I did not have a gig till the next weekend so I rested and went to see an ENT that following week. I was told then that my soft palate had shortened which I later learned had caused a condition called Velopharyngeal Stress Incompetence and that I would need surgery to fix it. The problem went away and I blew off the doctor’s diagnosis. The two years later it resurfaced but this time it took three days till I could comfortably blow the sax and retain pressure. At the time I was also performing a solo act (I also sing) so between the bands and the solo act I was putting in about 18 to 25 hours of performance each week. About 18 months later it happened again and this time it lasted a whole week before I could perform again. Since then it had increased in frequency and duration until in 2000 it hit near the end of a gig and never left. I could no longer play as I used to. I went in to a practice session of relearning how to play with very low pressure and also to detach from the energy exchanges with the audience, which make you want to play harder. Since I perform for a living this was a serious blow to not only my financial concerns but more over my joy and love of playing. I have limited myself to perform no more than two hours and those were low pressure gigs (like being wallpaper with sound). I player softer and turn up the microphone more but could not put in more than one and a half hours of actual performance and I had to reject external energy exchanges with my audience like the plague. In 2003 I saw another ENT who told me the same as the first and sent me to Stanford Medical in Palo Alto, California for evaluation and surgery. Since the problem was intermittent they sent me to a neurologist who prescribed Pyridostigmine Bromide for Myasthenia Gravis but stopped short of a diagnosis. After a while I could no longer afford the Stanford doctors and since I was a Veteran I turned to the VA for help. The first neurologist diagnosed Myasthenia Gravis but since the muscles to the soft palate did not respond to the medication he ruled that out and sent me in for a Barium Swallow Test. Though I did occasionally have food particles and liquid to come my nasal passage, my swallowing reflexes and closures we acceptable. I was then sent to another ENT and was told I needed to undergo a procedure to push the soft palate back for better closure with the back of the throat or to have injections into the soft palate to bulk it up. Each time, I tried to explain to the doctors that when the leak started it felt like something was on my palate and I could not snort or exhale it off and that it was very annoying. Finally, an ENT from Stanford was brought in and he actually listened to what I was saying and performed an Endoscopy exam of my soft palate. We not only saw the bubbles from the air leaking but also discovered that I have a cyst on my Uvula. Since I sing as much as I play the concern was for my ability to keep my performance foremost so removing the cyst would make matters worse than better. My biggest concern in this was my voice. The soft palate is one of the six articulators for speech so not only would I have needed speech therapy, but by closing the gap between the soft palate and the back of the throat my voice will be more nasal sounding. Even though there was a real good chance I would be able to play normally again I could not know how my fans who love my voice would respond, and that is if I could sing at all. Fortunately the cyst dissolved. Knowing for sure that my soft palate had shortened the next question was how to proceed. The doctor performed another Endoscopy exam while I was playing my Soprano Sax and once again we saw the air bubbles escaping while I played. My trying to keep the palate in contact was exhausting the palate muscles which caused it to drop and even more air escaped. The more air escaped, the drier the contact became and that was when the palate started to vibrate like a sheet in the wind and hurt. The MRI view of my palate showed that it was bulky alredy so we agreed on a procedure and on April 3rd 2008 I had injection surgery. The doctor injected a substance called Restylane, a cosmetic dermal filler, into the back wall of my throat, just above where the soft palate makes contact. I had to wait two weeks before I could test it out. Over the next 6 months the Restylane absorbed in to my body and I underwent another set of injections of a different material in December and as of today, June 29, 2009 it is still holding and I am blowing strong and more confident again. My doctor/surgeon is Dr. Richard L. Goode. Practicing at Stanford Medical Center he also provides care at the Palo Alto V.A. If you are a Veteran, you can get the procedure done cheap or free, depending on your income level. How did it feel after surgery/injections? The pain was not too bad, but there is a pressure sensation on the back of the neck during and for a few days after injections. There was some swelling and I did not want anything hard or crispy to eat for a few days and I was given, but only needed Vicodin for the first two. If you are a migraine sufferer, beware of using the nasal spray for the first two days. It does not bother the injection site buoh it sure hurts like hell for about 15 minuets. Also be aware that the pressure from the injections can seem as though you may be experiencing a migraine attack due to the feel of stiffness on the back of the neck. For those of you who may be experiencing this problem and can’t afford to undergo the procedure yet there are a few things you can do to help get you through the gig. 1. Be well rested and well hydrated. 2. Before the gig, take lukewarm water in though the nose. This is to cleanse any debris off the soft palate that may cause it not to make a good seal against the back of the throat. Sometimes mucus or some particle substance may need to be dislodged. All it takes is just a small opening for air to escape to cause a dry spot to form and spread (kind of like a leak in a dam). 3. While on the gig and when you start to feel the sensation, try these. Every chance you get, take a swig of ice cold water and swish it around the top/ back area of your mouth (where the soft palate meets the throat). This helps to sooth the area and keeps it moist. Also, if you are playing in a low humidity area, keep a cup of water close by. Remove the neck from the horn and soak the reed on mouthpiece on neck (not to lose tuning), as a dry reed requires more pressure on an already sensitive palate. 4. If this is an on going problem for you try reducing reed strength and lowering the pressure. This may not be an option in an acoustic ensemble unless you are playing with some really skilled and caring musicians who really want to play with you, however, if you use a microphone turn up the gain and EQ you monitor. 5. Once the condition strikes, stress becomes your worst enemy. There are no easy answers because each person’s musical responsibility is different than that of another. Just remember, keep your shoulders down. You can reduce most of your stress just by consciously dropping your shoulders. Take slow deep breaths in through the mouth and breathe out through the mouth. 6. Limit what and how much you play when the condition strikes. I know you want to play everything and you feel everything is important and your right, it is. However, reality is, you are not going to be able to play it all so choose your battles wisely. In other words, play what is the MOST important and layout for the least and last of all when it comes to solos, LESS really is MORE. Well, I hope this helps some of you out there. These are hard lessons I have experienced over the past years. It is no fun to deal with and it can really take the joy out of playing if you let it, however, don’t. Just do what you can, when you can, as much as you can and realize that even if it is just for a few minutes, you get to play the best musical instrument in the world. |